Poverty proofing Doncaster adult community mental health service 2026

Poverty proofing delivery partner model

Children North East are working in partnership with Rotherham, Doncaster and South Humber (RDaSH) NHS Trust to fulfil its ambitious promise to “poverty proof” all of its services by December 2025. The trust has committed to piloting a bespoke Delivery Partner Model developed in partnership with Children North East (CNE).

Poverty Proofing is a nationally recognised tool, designed to educate and enable health care professionals to identify, acknowledge, and reduce the impact of poverty, advocating for equality of access to healthcare, services and technologies that contribute to overall health outcomes experienced by those living in poverty.

A locally trained team (LTT) of people have been trained and are being supported by Children North East to carry out this work in line with the ethos and principles of Poverty Proofing.

• Phase 1: 3 model audits carried out by Children North East
• Phase 2: a further 6 audits carried out by the locally trained team with support from Children North East
• Phase 3: all other trust services will engage in the Poverty Proofing process during 2025 and 2026. Children North East will deliver training to all staff; the locally trained team will carry out scoping of services and engage patients and staff in consultations; and the trust strategy team members will deliver feedback and write reports for each service. Moving forward, services will become more poverty informed, learning how to work with their patients to identify barriers, so that poverty becomes everyone’s business, and no-one is left out or left behind

This whole system approach is unique and has accountability at every level and a commitment to alleviate barriers that apply across the whole system.

Poverty proofing ethos

No activity or planned activity should identify, exclude, treat differently or make assumptions about those whose household income or resources are lower than others.

Voice

The voice of those affected by poverty is central to understanding and overcoming the barriers that they face.

Place

We recognise that poverty impacts places differently, and so understanding place is vital in our response. Organisationally we also need to be clear about why and how decisions are made. This understanding of context is essential.

Structural inequalities

The root causes of poverty are structural. What structural changes can we make at an organisational level to eliminate the barriers that those in poverty may face.

Poverty proofing process

Stage 1: training and consultation with staff

​​15​ staff completed a ​three-hour​ training session.

Stage 2: scoping

Time was spent gathering information about the setting and how it works. This stage included conversations with staff and management. 19 staff (in different roles) were spoken to in 1-to-1 conversations and via a survey.

Stage 3: patient and community consultations

We consulted with ​130​ people in total via a survey.

Stage 4: feedback session

Findings were written up into this final report.

Stage 5: review

Around ​nine​ months after completion, the trust will complete a review, identifying impact, good practice and potential considerations moving forward.

Common themes

The next sections of this report highlight the most common themes to come out of the poverty proofing consultations. For each theme the report covers:

• what works, what you do now that supports those experiencing poverty
• the barriers and challenges faced by those experiencing poverty
• recommendations, each recommendation comes with a set of considerations for “poverty proofing” the service

The themes are presented alphabetically, and this does not imply any hierarchy of importance. The themes for Doncaster adult community mental health were:

• communication
• navigating and negotiating appointments
• patient empowerment
• staff awareness and guidance
• travel

Communication

Communication is important to consider in Poverty Proofing both from a health literacy perspective of how information is communicated and understood and in ensuring there are reciprocal lines of communication between services and service users. O’Dowd (2020) reported that availability of care was a particular concern for those on a low income and there were significant inequalities in care availability for the most deprived areas. Communication is a key factor in ensuring availability of care.

What works

The service is pro-active in instigating conversations about finances

Instigating conversations about poverty with patients is an important aspect of providing holistic and equitable care within the service because financial insecurity can contribute to stress, anxiety, depression and worsening mental health. The Doncaster adult community mental health team service conducts a risk assessment with each patient, and this assessment includes questions around a person’s financial stability. The answers to these questions helps the service to identify practical difficulties that may be affecting recovery and means they can signpost patients to appropriate financial, social and community support.

Staff:

“It’s also part of the risk assessment… there is a section on there where it says current or historical financial difficulties.”

“It’s a standard question that I ask what benefits are you receiving and do you have any debt problems?”

“It’s a standard thing that I explore with patients at each clinic review.”

Barriers and challenges

Difficulties with translation services

Staff describe telephone-based communication as a less effective and sometimes frustrating way of supporting patients, when interpretation is required. Technical problems can make conversations feel clunky and disrupt communication. These difficulties become greater when a patient is accompanied by a relative or carer, as staff may need to manage a three-way conversation between themselves, the patient, and the family member or interpreter. This can make it difficult to follow the conversation, ensure information is translated accurately, and maintain the intended triangle of care involving the patient, their carer, and the clinician.

Staff:

“A less helpful experience was, you know, when you’re trying to talk through the phone. So when you’re using a phone or the triangle… sometimes the technology just doesn’t work as well as it should. And that can be a bit clunky.”

“I’ve had challenges using the telephone service… particularly when the patient has a relative with them who’s their carer. We try to embrace that triangle of care, but trying to keep up with what everybody’s saying and having it translated back to you can be very difficult.”

Difficulties with creating boundaries with patients regarding out-of-hours calls

During staff consultations, some colleagues flagged that there are some difficulties with creating effective boundaries around out-of-hours calls. Community staff are provided with work phones, meaning they do not need to use personal numbers when communicating with patients. Because trust colleagues have developed a strong rapport with patients as their lead professional, patients may contact them directly when they need urgent support, even when they have been told that the service operates only during office hours. To manage this risk, colleagues now prefer to give patients the central office contact number (03000 number) rather than their direct work number.

This highlights a confusion between continuity of care and professional boundaries. Having a direct contact number can strengthen relationships, improve accessibility and make patients feel supported, but it can also create an expectation that the colleague is available whenever needed.

Conversely, out of 130 patient consultations, no patients flagged concerns about out-of-office contact. In fact, some patients praised the switchboard staff.

Staff:

“So there is that ability to give clients your number. However, from personal experience, it’s a bit of a difficult area because depending on the client that, you know, like if people are going into crisis, you explicitly explain to people like we’re a 9am to 5pm service, but unfortunately sometimes because you’re the lead professional then people might reach out to you.”

Patient:

“Ella and the switchboard was very pleasant to deal with.”

Recommendations for communication

Difficulties with translation service

• The trust should look into the current translation service (LE) and consider any difficulties which colleagues may be facing based on the above feedback.
• Where possible, colleagues could consider face-to-face or video interpreting, particularly for more complex consultations or when a carer is involved. Seeing everyone can make turn-taking and non-verbal communication easier.
• Book professional interpreters in advance for appointments where communication is likely to be complex, rather than relying on carers or families.

Difficulties with creating boundaries with patients regarding out of hours calls

• Colleagues need communication arrangements that allow patients and carers to access support easily while making it clear who to contact, when, and for what type of support.
• Clearer guidance about the use of work phones, out-of-hours procedures and alternative crisis contacts could help achieve this balance.

Navigating and negotiating appointments

Life can be particularly unpredictable when living on a low income. The challenges, for example around childcare or zero hours’ contracts can make attending appointments very difficult. Pressures on the NHS around waiting times and stretched services can mean there is little scope for flexibility and strict discharge policies are applied for those who miss appointments, effectively severing access for those with changeable circumstances. Furthermore, social problems often accompany poverty, and sometimes life can be chaotic, which makes consistent appointment attendance difficult. Availability and flexibility of care are important for improving access to health care for those on a low income.

The King’s Fund (2021) report states that:

“Services need to be flexible, accessible, responsive and offer continuity of care.”

What works

Some flexibility with appointments

Patients really appreciate when flexibility is offered by practitioners. This includes timings of appointments, to allow patients to work around employment commitments, wherever possible. There is also some flexibility around appointments. From a poverty perspective, appointment flexibility is really positive practice, as it helps reduce not only the financial cost of travel, but also the time taken out of someone’s day to attend.

Staff:

“We do offer home visits.”

Barriers and challenges

Time off work to come to appointments

Despite the flexibility described above, this is only possible within the wider service structure of 9am to 5pm, Monday to Friday.

When asked to identify any barriers they see in the service, staff described parents needing to take time off work to attend appointments as being a significant challenge. This might mean unpaid time away from work, and may create tension with an employer about repeated time off, potentially resulting in earning loss or even job loss.

Patient:

“Being off work.”

Communication around appointment flexibility

During the audit process, it was evident that there is some flexibility around appointments for patients, with appointment options for them to select from if needed. However, it seems that not all patients are aware of these:

Some patients were asking for more options during consultations, which means that there likely needs to be improved communication around what options are available to them from of the onset.

Patients:

“Video calls if someone can’t get into an appointment. I don’t want to miss appointments because I can’t travel.”

“More appointment flexibility, can’t use the bus due to mental health.”

“I can’t make appointments as I’ve had a big change in circumstances, long term sick now and also making it uncomfortable due to high anxiety and not going on public transport.”

Recommendations for navigating and negotiating appointments

Time off work to come to appointments

• Consider expanding routine service hours, for example, until 7pm and occasional weekends. Ensure this is a service-wide policy, not dependent on individual staff flexibility.
• Offer more remote and virtual appointments where appropriate.
• Ask about availability at point of referral and allocate practitioners accordingly.
• Help families negotiate time off with their employer by providing simple appointment letters explaining NHS attendance requirement and the importance of parental involvement.

Communication around appointment flexibility

The service should look to improve communications about what appointment options are available to patients, right from the point of referral into the pathway. The options are already there, but it seems not all patients are aware, and many may not feel empowered enough to ask for adaptations.

Page last updated: November 06, 2026

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